Health plans and TPAs

Health plans are insurance policies that private companies or government programs offer to cover healthcare costs for enrolled individuals. Third-party administrators manage and process insurance claims for these health and employee benefit plans, often serving as intermediaries among healthcare providers, payers and beneficiaries.

Top Stories

News 21 Jan 2026
Medicare Advantage overpayments will total $76B this year: MedPAC

The federal government will pay an estimated $76 billion more to cover Medicare Advantage seniors this year than it would if those same seniors were in traditional Medicare, according to new estimates from an influential advisory group. Continue Reading

— Healthcare Dive
News 13 Jan 2026
UnitedHealth ‘aggressively’ gaming Medicare Advantage, Senate investigation finds

Staffers for Sen. Chuck Grassley, R-Iowa, dove into 50,000 pages of documentation from UnitedHealth for the new report, which accuses the company of maintaining a workforce dedicated to upcoding. Continue Reading

— Healthcare Dive

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xtelligent Rev Cycle Management

Trinity Health to lay off 10.5% of revenue cycle headcount
The Michigan-based health system said financial headwinds, including heightened costs, low reimbursement and federal policy ...
R1 adds prior authorization solution to new revenue cycle OS
R1 announced a new prior authorization solution as part of the Phare OS that seek to automate and scale the process for faster ...
Healthcare leaders expect AI maturity this year, especially in RCM
A new report shows low AI maturity despite widespread adoption in the revenue cycle. Still, leaders expect to mature rapidly over...

xtelligent Virtual Healthcare

Study: Telehealth use doesn't increase healthcare utilization
The post-pandemic rise in telehealth adoption did not result in a concurrent increase in outpatient office visits, despite ...
Getting ready for the AI era of virtual healthcare
With AI integration expected to grow in 2026, virtual care leaders must implement AI management strategies to ensure safe, ...
How providers can prepare for the upcoming telehealth cliff
Telehealth flexibilities are set to expire on Jan. 30, 2026, but there are strategies that can help healthcare providers navigate...

xtelligent Patient Engagement

Consumers turn to AI to fill in healthcare experience gaps
Patients are frustrated with healthcare access and insurance navigation. Is AI the tool that could fill in the gap?
Amazon One Medical unveils Health AI assistant for patients
Amazon One Medical's Health AI assistant is designed to help patients manage their healthcare experiences with the context of ...
How nurses assess care goals to boost patient satisfaction
Nurses at New Jersey's Valley Hospital boosted patient satisfaction by 14% by soliciting and understanding patient care goals.

xtelligent Health IT and EHR

Epic denies anticompetitive claims made in Texas AG's suit
In response to the lawsuit, Epic detailed its efforts to advance interoperability and its customizable software that enables ...
KLAS: Ambient speech remains healthcare's top AI use case
Leaders are cautious about higher stakes, care-transformative applications, a new KLAS report shows.
Epic, health systems file lawsuit alleging HIE exploitation
The lawsuit details a scheme in which health organizations are using HIE interoperability frameworks to access and use patient ...

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